Regional anesthesia and pain medicine
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Reg Anesth Pain Med · Mar 2010
ReviewThe ASRA evidence-based medicine assessment of ultrasound-guided regional anesthesia and pain medicine: Executive summary.
The American Society of Regional Anesthesia and Pain Medicine charged an expert panel to examine the evidence basis for ultrasound guidance as a nerve localization tool in the clinical practices of regional anesthesia and interventional pain medicine. ⋯ Ultrasound guidance improves block characteristics (particularly performance time and surrogate measures of success) that are often block specific and that may impart an efficiency advantage depending on individual practitioner circumstances. Evidence for UGRA impacting patient safety is currently limited to the demonstration of improvements in the frequency of surrogate events for serious complications.
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Reg Anesth Pain Med · Mar 2010
Review Comparative StudyEvidence basis for the use of ultrasound for upper-extremity blocks.
This article qualitatively assesses and summarizes randomized, controlled studies regarding benefits of ultrasound (US) for brachial plexus block and also examines those studies that have compared different brachial plexus block techniques using US. Studies were identified by a search of PUBMED and EMBASE databases using the MeSH terms anesthetic techniques, brachial plexus, and ultrasound. Included studies were limited to randomized trials that compared a US technique with another accepted method of performing brachial plexus block or those studies that compared 2 different US-guided techniques. ⋯ Twenty-five studies met inclusion criteria, with 19 studies comparing US techniques with other nerve location methods and 6 studies comparing different US techniques. Of the former, there was convincing evidence to support the use of US, with 15 of 19 studies demonstrating improved outcomes compared with existing techniques. Ultrasound provides significant advantages when performing brachial plexus block including faster sensory block onset and greater block success.
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Reg Anesth Pain Med · Mar 2010
Randomized Controlled TrialUltrasound does not improve the success rate of a deep peroneal nerve block at the ankle.
The deep peroneal nerve is 1 of 5 nerves anesthetized when performing an ankle block. Multiple techniques of blocking the deep peroneal nerve have been described, but little evidence exists to delineate the efficacy of any one technique. We hypothesized that ultrasound would increase both the success rate and the quality of a deep peroneal nerve block at the ankle. ⋯ The use of ultrasound seems to improve the onset of deep peroneal nerve block at the ankle but does not improve the overall quality of the block.
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Reg Anesth Pain Med · Mar 2010
Review Practice GuidelineASRA practice advisory on local anesthetic systemic toxicity.
The American Society of Regional Anesthesia and Pain Medicine Practice Advisory on Local Anesthetic Systemic Toxicity assimilates and summarizes current knowledge regarding the prevention, diagnosis, and treatment of this potentially fatal complication. It offers evidence-based and/or expert opinion-based recommendations for all physicians and advanced practitioners who routinely administer local anesthetics in potentially toxic doses. ⋯ When objective evidence is lacking or incomplete, recommendations are supplemented by expert opinion from the Practice Advisory Panel plus input from other experts, medical specialty groups, and open forum. Specific recommendations are offered for the prevention, diagnosis, and treatment of local anesthetic systemic toxicity.